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addiction their responses suggested marked variation with no information available for some subjects and only third party report on the ‘likely’ withdrawal symptoms of one subject. Yet another described inability to sleep as the only withdrawal symptom reported. A second methodological problem is one of the nature of the follow-up. Follow-up data appear to have been obtained from relatives’ reports in all but one case.
The study, while containing methodological problems serious enough to cast doubt on the accuracy of its findings, did throw into question the received wisdom of the day on the nature of alcoholism and opened up research questions that had not been pursued to any great extent. In a report of a further twenty-five year follow-up of these patients, Edwards (1985) has questioned the validity of the follow-up data of the time for all but one of the subjects. He does, however, stress that in spite of its methodological weaknesses the study gave the much needed impetus to open up the debate on the nature of alcoholism.
Laboratory experiments with alcoholics conducted by Mello and Mendelson questioned the tenet of loss of control by showing that even severely dependent drinkers’ levels of consumption were not determined by the amount of alcohol available. Using operant methods, these researchers showed that levels of consumption were a function of the amount of work required to obtain alcohol and by the achievement and maintenance of a particular blood alcohol level (Mello and Mendelson 1965; Mello et al. 1968). Further research on the nature of loss of control is discussed in Chapter 5. With the central tenets of loss of control and the inevitability of deterioration called in to question, clearly new theorising was required to account for the emerging findings. This theorising centred on the ‘alcohol dependence syndrome’ and later the ‘drug dependence syndrome’ (Edwards et al. 1982).
The alcohol dependence syndrome was distinguished from the concept of alcoholism which preceded it in that it was based in the disaggregation of the former concept into separate domains of dependence and alcohol related disabilities, the latter referring to adverse consequences in the physical, psychological and social spheres (Edwards et al. 1977a; Edwards et al. 1982). This bi-axial distinction was further elaborated into a multi-axial model of problem drinking in the light of studies which identified that heavy consumption formed a separate dimension. Notable amongst these was the study conducted by the Rand Corporation (Polich et al. 1981) in which consequences of drinking were found to be only weakly related to dependence and patterns of consumption. Polich and his colleagues followed up over four years 85% of an original sample of 922 males who contacted treatment agencies in the US during 1973. Limitations of this sample were that, being an exclusively male sample, it is difficult to say whether the relationship between dependence and
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